Table 1.
Study | IDa | CAB PKb ≤Q1 | RPV PKb ≤Q1 | HIV-1 subtype A6/A1 | Baseline IN L74Ic | Baseline INSTI mutationd | Baseline Proviral RPV RAMe | Baseline NNRTI RAMf | Female sex at birthg | BMI ≥30 kg/m2 | Q8W |
ATLAS-2M | 1 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||
ATLAS-2M | 2 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
ATLAS | 3 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
ATLAS | 4 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
FLAIR | 5 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
FLAIR | 6 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
FLAIR | 7 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ||||
ATLAS-2M | 8 | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | |||
ATLAS-2M | 9 | ✓ | ✓ | ||||||||
ATLAS | 10 | ✓ | ✓ | ✓ | |||||||
ATLAS-2M | 11 | ✓ | ✓ | ✓ | ✓ | ||||||
ATLAS-2M | 12 | ✓ | ✓ | ||||||||
ATLAS-2M | 13 | ✓ |
CAB, cabotegravir; CVF, confirmed virologic failure; IN, integrase; INSTI, integrase strand transfer inhibitor; NNRTI, nonnucleoside reverse transcriptase inhibitor; PK, pharmacokinetics; Q1, first quartile; Q8W, every 8 weeks; RAM, resistance-associated mutation; RPV, rilpivirine.
Participants were from study sites in Russia (n = 6), France (n = 2), US (n = 2), Spain (n = 1), South Africa (n = 1), Canada (n = 1). Follow-up at Russian study sites did not find clustering of failures at any one particular site, reducing the likelihood of drug administration errors being the cause.
CAB and RPV PK refer to Week 8 trough concentrations (4 weeks following first injections); Q1 refers to the lowest quartile of the Week 8 trough concentration.
Excluding mixtures with L74M.
Excluding L74I (excluding mixtures with L74M).
Reduced RPV susceptibility was observed with 11/13 participants at CVF. Baseline genotype and phenotype were analysed using viral RNA from plasma samples in FLAIR and viral DNA from peripheral blood mononuclear cell samples in ATLAS and ATLAS-2M.
Excluding RPV RAMs.
There were six out of 1039 (<1%) participants included in the analysis whose self-reported gender differed from sex at birth – none of these six participants reported CVF.